Project Summary/Abstract Suicidal ideation is prevalent and impairing in youth, with approximately 15% of high school students reporting seriously considering a suicide attempt and making a specific plan for suicide in the past 12 months Substantial evidence documents perceived burdensomeness towards others, or the belief that one is a burden or drain on others, as a risk factor for suicidal ideation in youth. This evidence highlights the potential promise of perceived burdensomeness as a novel intervention target to reduce suicidal ideation in youth. However, only one pilot study, conducted by the sponsor, has examined an intervention targeting perceived burdensomeness in youth, and that study used a brief online intervention administered to a relatively low risk community sample. The current proposal seeks to leverage the sponsor?s clinical trial to enable the applicant to assist in the development and preliminary evaluation of a novel, brief psychosocial treatment module targeting perceived burdensomeness in youth that can be embedded within existing psychosocial treatments. Outpatient youth clinical services represent a critical window of opportunity for selective prevention of perceived burdensomeness in at-risk youth. The current proposal thus extends ongoing outpatient cognitive behavioral treatment (CBT) for anxiety or depression to implement a brief, minimally disruptive, parent-involved module targeting perceived burdensomeness. The first aim of this proposal is to assist the sponsor in developing a novel, brief psychosocial intervention module (the GIVE module) targeting perceived burdensomeness towards others that can be embedded within existing CBT protocols for youth internalizing problems. The second aim is to collect qualitative and quantitative data relevant to cultural adaptation, acceptability, and satisfaction, as well as preliminary data on the timing of reductions in perceived burdensomeness. Participants will be N=30 clinic- referred youth ages 10 to 17 with anxiety and depression-related difficulties and their parents who are part of the sponsor?s open trial of the GIVE module in a large university-based clinic, who display high levels of perceived burdensomeness. The GIVE module will be administered during CBT session 6 and then briefly reviewed in CBT session 7. It is hypothesized that perceived burdensomeness will be significantly lower after the GIVE module. The proposed research is expected to provide additional, rich quantitative and qualitative data on the sponsor?s GIVE module trial. This data will further spur the refinement of this novel module targeting an identified risk factor for suicidal ideation that can be efficiently implemented within the context of ongoing psychosocial treatments for at-risk youths with anxiety and/or depression. With these research findings in hand, the applicant and his sponsor will be positioned to refine and evaluate the module in a randomized controlled trial.